Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-23T01:36:26.390Z Has data issue: false hasContentIssue false
  • English
  • Français

Maxillofacial Injury—Not Always a Difficult Airway

Published online by Cambridge University Press:  21 May 2015

John Glasheen ,
David Hennelly  and
Stephen Cusack
John Glasheen*
Affiliation:
Emergency Department, Cork University Hospital, Cork, Ireland
David Hennelly
Affiliation:
Clinical Development, National Ambulance Service, Limerick, Ireland
Stephen Cusack
Affiliation:
Emergency Department, Cork University Hospital, Cork, Ireland
*
Correspondence: John Glasheen, MB, BCh, BAO, MScEMS Emergency Department Cork University Hospital Cork, Ireland E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

The optimal method for securing the airway in injured patients is controversial. Maxillofacial injury has been shown to be a marker for difficult airway management; however, a delay in intubation may result in deterioration of intubating conditions due to further airway bleeding and swelling. Decisions on the timing and method of airway management depend on multiple factors, including patient characteristics, the skill set of the clinicians, and logistical considerations. This report describes the case of a multi-agency response to a motor-vehicle collision in a rural area in Ireland. One young male patient had sustained significant maxillofacial injuries, multiple limb injuries, and had a decreased level of consciousness. Further airway compromise occurred following extrication. Difficult intubation was predicted; however, abnormal jaw mobility from bilateral mandibular fractures enabled easy laryngoscopy and intubation. Although preparation must be made for difficult airway management in the setting of maxillofacial injury, appropriately trained and experienced practitioners should not be deterred from performing early intubation when indicated.

Glasheen J, Hennelly D, Cusack S. Maxillofacial Injury—Not Always a Difficult Airway. Prehosp Disaster Med. 2015;30(4):1 –4.

Keywords

maxillofacialprehospital caretrauma
Type
Case Report
Information
Prehospital and Disaster Medicine , Volume 30 , Issue 4 , August 2015 , pp. 421 - 424
Copyright
© World Association for Disaster and Emergency Medicine 2015 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Gruen, RL, Jurkovich, GJ, McIntyre, LK, Foy, HM, Maier, RV. Patterns of errors contributing to trauma mortality: lessons learned from 2,594 deaths. Ann Surg. 2006;244(3):371-380.Google Scholar
2. Tung, TC, Tseng, WS, Chen, CT, Lai, JP, Chen, YR. Acute life-threatening injuries in facial fracture patients: a review of 1,025 patients. J Trauma. 2000;49(3):420-424.Google Scholar
3. Mayglothling, J, Duane, TM, Gibbs, M, et al. Eastern Association for the Surgery of Trauma. Emergency tracheal intubation immediately following traumatic injury: an Eastern Association for the Surgery of Trauma practice management guideline. J Trauma Acute Care Surg. 2012;73(5 Suppl 4):S333-S340.CrossRefGoogle ScholarPubMed
4. Boer, C, Franschman, G, Loer, SA. Prehospital management of severe traumatic brain injury: concepts and ongoing controversies. Curr Opin Anaesthesiol. 2012;25(5):556-562.Google Scholar
5. Evans, CC, Brison, RJ, Howes, D, Stiell, IG, Pickett, W. Prehospital non-drug assisted intubation for adult trauma patients with a Glasgow Coma Score less than 9. Emerg Med J. 2013;30(11):935-941.Google Scholar
6. Karamanos, E, Talving, P, Skiada, D, et al. Is prehospital endotracheal intubation associated with improved outcomes in isolated severe head injury? A matched cohort analysis. Prehosp Disaster Med. 2014;29(1):32-36.Google Scholar
7. Cudnik, MT, Newgard, CD, Daya, M, Jui, J. The impact of rapid sequence intubation on trauma patient mortality in attempted prehospital intubation. J Emerg Med. 2010;38(2):175-181.CrossRefGoogle ScholarPubMed
8. Bernard, SA, Nguyen, V, Cameron, P, et al. Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Ann Surg. 2010;252(6):959-965.CrossRefGoogle ScholarPubMed
9. McQueen, C, Crombie, N, Hulme, J, et al. Prehospital anaesthesia performed by physician/critical care paramedic teams in a major trauma network in the UK: a 12 month review of practice. Emerg Med J. 2015;32(1):65-69.Google Scholar
10. von Vopelius-Feldt, J, Benger, JR. Prehospital anaesthesia by a physician and paramedic critical care team in Southwest England. J Emerg Med. 2013;20(6):382-386.Google Scholar
11. Kamiutsuri, K, Okutani, R, Kozawa, S. Analysis of prehospital endotracheal intubation performed by emergency physicians: retrospective survey of a single emergency medical center in Japan. J Anesth. 2013;27(3):374-379.CrossRefGoogle ScholarPubMed
12. Sollid, SJ, Lossius, HM, Søreide, E. Pre-hospital intubation by anaesthesiologists in patients with severe trauma: an audit of a Norwegian helicopter emergency medical service. Scand J Trauma Resusc Emerg Med. 2010;18:30.Google Scholar
13. Crewdson, K, Lockey, DJ. An observational study of intubation success rates and rescue airway techniques among 7,256 pre-hospital physician intubations of trauma patients. Scand J Trauma Resusc Emerg Med. 2014;22(1):788.Google Scholar
14. Boer, C, Franschman, G, Loer, SA. Prehospital management of severe traumatic brain injury: concepts and ongoing controversies. Curr Opin Anaesthesiol. 2012;25(5):556-562.Google Scholar
15. Cormack, RS, Lehane, J. Difficult tracheal intubation in obstetrics. Anaesthesia. 1984;39:1105-1111.Google Scholar
16. Perry, M, Morris, C. Advanced Trauma Life Support (ATLS) and facial trauma: can one size fit all? Part 2: ATLS, maxillofacial injuries and airway management dilemmas. Int J Oral Maxillofac Surg. 2008;37(4):309-320.Google Scholar
17. Combes, X, Jabre, P, Jbeili, C, et al. Prehospital standardization of medical airway management: incidence and risk factors of difficult airway. Acad Emerg Med. 2006;13(8):828-834.CrossRefGoogle ScholarPubMed
18. Slagt, C, Zondervan, A, Patka, P, de Lange, JJ. A retrospective evaluation performed of the intubations performed during five years of helicopter emergency medical service in Amsterdam. Air Med J. 2004;23(5):36-37.CrossRefGoogle Scholar
19. Kellman, RM, Losquadro, WD. Comprehensive airway management of patients with maxillofacial trauma. Craniomax- illofac Trauma Reconstr. 2008;1:39-48.Google Scholar
20. Breckwoldt, J, Klemstein, S, Brunne, B, Schnitzer, L, Mochmann, HC, Arntz, HR. Difficult prehospital endotracheal intubation - predisposing factors in a physician based EMS. Resuscitation. 2011;82(12):1519-1524.CrossRefGoogle Scholar
21. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support Program for Doctors. 8th ed. Chicago, Illinois USA: American College of Surgeons; 2008.Google Scholar
22. National Association of Emergency Medical Technicians. Prehospital Trauma Life Support. 7th ed. Sudbury, Massachusetts USA: Jones & Bartlett; 2010.Google Scholar
23. Hutchison, I, Lawlor, M, Skinner, D. ABC of Major Trauma. Major maxillofacial injuries. BMJ. 1990;301:595-599.Google Scholar
24. Morrissette, MP, Chewning, LC. Rapid airway compromise following traumatic laceration of the facial artery. J Oral Maxillofac Surg. 1990;48:989-990.CrossRefGoogle ScholarPubMed
25. Ardekian, L, Rosen, D, Klein, Y, Peled, M, Michaelson, M, Laufer, D. Life-threatening complications and irreversible damage following maxillofacial trauma. Injury. 1998;29(4):253-256.Google Scholar
26. Chase, CR, Hebert, JC, Farnham, JE. Post-traumatic upper airway obstruction secondary to a lingual artery hematoma. J Trauma. 1987;27:953-954.Google Scholar
27. King, HK. Airway managements of patients with maxillofacial trauma. Acta Anaesthesiol Sin. 1996;34(4):213-220.Google ScholarPubMed
28. Bredmose, PP, Rock, S, Lockey, DJ. Prehospital tracheal intubation in severe facial trauma: a short window of opportunity. Emerg Med J. 2012;29(9):767-768.Google Scholar
29. Mort, TC. Emergency tracheal intubation; complications associated with repeated larynogoscopic attempts. Anesth Analg. 2004;99:607-613.Google Scholar
30. Greater Sydney Area HEMS RSI Manual. Greater Sydney Area HEMS Web site. www.sydneyhems.com/. Accessed May 15, 2014.Google Scholar
31. Murphy, AP, Doran, HJ, O'Sullivan, I, Sleeman, D, Cusack, SP. The McKesson prop--an essential tool for the emergency physician? Emerg Med J. 2010;27(2):156-158.Google Scholar
32. Cobas, MA, De la Peña, MA, Manning, R, Candiotti, K, Varon, AJ. Prehospital intubations and mortality: a Level 1 trauma center perspective. Anesth Analg. 2009;109(2):489-493.Google Scholar